Hypertension is a serious public health concern, disturbing millions of lives worldwide. Effective lifestyle modifications are the foundation for the prevention and control of hypertension. The aim of this study is to assess adherence to lifestyle modifications and associated factors among adult hypertensive patients in West Shoa, Oromia, Ethiopia. An institutional-based cross-sectional study design was employed from August 20 to September 20, 2023. A systematic random sampling technique was employed to select study participants. A binary logistic regression model was used to check the association between independent and outcome variables. The strength of the association was stated using an adjusted odds ratio with a 95% confidence interval and a p-value of <
0.05. The study included 316 study participants, with a 98.8% response rate. The magnitude of adherence to lifestyle modifications was 31% (95%CI: 25.7-36.1%). Age (AOR = 2.71, 95% CI: 1.19-6.19), residence (AOR = 0.19, 95%CI: 0.09-0.39), duration of treatment (AOR = 2.17, 95%CI: 1.14-4.13), attitude (AOR = 2.14, 95%CI: 1.06-4.30), perceived social support (AOR = 6.23, 95%CI: 3.18-12.22) and self-efficacy (AOR = 2.66, 95%CI: 1.25-5.69) were the independent predictors of lifestyle modifications adherence. This study found that adherence to lifestyle modifications was low among hypertensive patients.